WCCS26: Abstract 'Presenting a Universal and Simple Conceptual Workbench to Situate and Encompass Complexity'

ABSTRACT

Background

In health and social care there is, as yet, no universally recognised model, or framework applied and taught across all academia, fields of practice, professional disciplines and apprenticeships. At a time when ‘truth’ is challenged by information disorder, AI, and curricula are overload, this is both a stark and hidden problem. Medicine was quick to embrace complexity as an additional scientific tool. Complexity extends our understanding of epidemiology, demographic trends, the birth of modern bio-genomics, pharmacokinetics, public health, workflows, patient safety and more. The medical and bio-medical models are subject to critique, especially in psychiatry in terms of their conceptual scope and holistic bandwidth. Consider for example, the representation of patient and public engagement, human rights, climate change, poverty, refugees and natural disasters? The field of psychiatry extended these models to the bio-psycho-social model.

Methods

Despite this ‘progress-ion’, profound legacy issues remain: 

• The dualities of INDIVIDUAL-GROUP and HUMANISTIC-MECHANISTIC
• Sustainable services and systems, change to emphasize prevention and education (not just cure)
• A lack of parity of esteem between mental illness and physical illness
• A complicated relationship between psychiatry and psychology

The 21st century demands we also factor in economics, technology, social media - especially AI, education and literacies, geopolitics, security and more. This paper argues that we need a bio-psycho-socio-political model stat! This paper introduces and demonstrate the generic conceptual framework known as Hodges’ model.

To date, Hodges’ model has been explained and studied by guided discovery through lectures, workshops, posters, show and tell, and discussion groups; plus descriptive means of case study, and in practice patient care assessments and case formulation. Journal papers include conceptual analysis and synthesis, concept mapping of issues, e.g. nutrition and the sustainable development goals, plus oral health and policy frameworks (in-process). This paper ‘workbench’ encourages and facilitates reflective practice and critical thinking on an individual and collective basis. The derivation of the structure and content of Hodges’ model through guided discovery will be shared.

Results & Discussion

The background to Hodges’ model and its creation is introduced. In health care delivery, evidence-based interventions are of course paramount to patient, and public safety. Work to ‘see’ Hodges’ model as a mathematical object has begun. Help and collaboration is welcome; especially with supervisors of early career researchers and scholars in LMICs. Examples of complexity will be mapped to the knowledge (care) domains of Hodges’ model, which can itself be embedded within the spiritual. This paper responds directly to WCCS26’s main theme; and the need to listen to the lessons of history and isolate, weigh, refine and seek to preserve the often hard-won values that sustain humanity, humanistic care and qualities at a time when these are under assault, e.g. assisted dying – a right to die, or a duty? A small but growing bibliography, a template, plus illustrations of Hodges’ model are provided. Background on Hodges’ model can be found in the blog ‘Welcome to the QUAD’ - https://hodges-model.blogspot.com

Keywords: Healthcare, Nursing, Hodges’ model, Humanities, Global health

Topic: Complexity in Health and Medicine

🔷

News of acceptance was received on 29th November: brilliant! The deadline for submission of full-papers is 25th December. Try as I might, I can't meet this date. 

Helpfully, a presentation based on abstract alone is acceptable. I am hoping to network and learn too. The draft notes on Hodges'model as a mathematical object (6k words) are helpful in framing thoughts about the presentation and a future paper as a writing project. All in, a marvellous end to 2025 and prospect for 2026.

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Liberation and Corruption: Why Freedom Movements Fail

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Reckoning: Creating Positive Change Through Radical Empathy

by Terri Givens
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Mind the Inclusion Gap: How Allies Can Bridge the Divide Between Talking Diversity and Taking Action

by Suzy Levy
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White Privilege: The myth of a post-racial society

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My source: https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=EUROPEAN-SOCIOLOGIST

Bourdieu: systems, axes, maps, practical logics

I have checked these quotes and am fairly sure they are accurate. The first, I feel, improves with re-reading, and presents a clearing at the end? 

The clearing could be a template, and as per the second it may be old; but retains its practical function.

'Intellectualism is inscribed in the fact of introducing into the object the intellectual relation to the object, of substituting the observer's relation to practice for the practical relation to practice. Anthropologists would be able to escape from all their metaphysical questioning about the ontological status or even the 'site' of culture only if they were to objectify their relation to the object, that of the outsider who has to procure a substitute for practical mastery in the form of an objectified model. Genealogies and other models are to the social orientation which makes possible the relation of immediate immanence to the familiar world, as a map, an abstract mode of all possible routes, is to the practical sense of space, a "system of axes linked unalterably to our bodies, which we carry about with us wherever we go", as Poincaré put it.' p.34.

The Logic of Practice

'The logical [kinship] relations he constructs are to 'practical' relations - practical because continuously practised, kept up and cultivated - as the geometrical space of a map, a representation of all possible routes for all possible subjects, is to the network of pathways that are really maintained and used, 'beaten tracks' that are really practicable for a particular agent. The family tree, a spatial diagram that can be taken in at a glance, uno intuitu and scanned indifferently in any direction from any point, causes the complete network of kinship relations over several generations to exist in the mode of temporal existence which is that of theoretical objects, that is, tota simul, as a totality in simultaneity. It puts on the same footing official relationships, which, for lack of regular maintenance, tend to become what they are for the genealogist, that is, theoretical relationships, like abandoned roads on an old map; and practical relationships which really function because they fulfil practical functions.' p.35.

My source:

Bourdieu, P. (1990). The Logic of Practice. Stanford University Press. https://doi.org/10.1515/9781503621749 [and image source].

Bourdieu, Pierre, "The Logic of Practice (1990)" (1990). eTextbooks for Students. 875.
https://stars.library.ucf.edu/etextbooks/875

See also: https://hodges-model.blogspot.com/search?q=bourdieu

Problem solving, case formulation and policy formulation

On W2tQ this year, and possibly in a previous paper, or conference presentation, I've stated that the nursing process is basically a problem solving algorithm. Nothing profound there of course. 

'Problem solving' is a developmental threshold and an evolutionary skill obvious in humans, with learning passed on across generations. Evidence of problem solving in animals and nature is becoming increasingly apparent; with examples over recent decades of problems solved not witnessed before.

In healthcare, and psychotherapy more specifically, we shift to case formulation. Again a step-wise process to arise at a sufficiently complete rationale for therapy. Ideally, this extends beyond the individual. As an parent, grandparent, guardian, teacher, supervisor ... teaches a child so therapy is an opportunity for learning and, it must be added, unlearning.

Returning to (and passing on):

Hague, R., & Harrop, M. (2007). Comparative Government and Politics (7th ed.). New York, NY: Palgrave Macmillan.

Chapter 18 (pp.377-395) concerns 'Public Policy'. Clearly, here there is a shift from the individual to the collective, population and citizenry. The chapter's second page on 'Initiation and Formulation' quickly provides a flowchart 'Figure 18.1 Stages of the policy process'. Box 18.1 informs readers about 'Rational and incremental models and policy-making' (p.380):

'The key contrast between the two models is this. The rational model views policy formulation as emerging from a systematic search for the most efficient means of achieving defined goals. By contrast, the incremental model sees policy as emerging from a compromise between actors who have goals which are ill-defined or even contradictory. Where the rational model seeks the best policy in theory, an incremental framework seeks out a practical policy acceptable to all the interests involved.' p.380.

The book highlights Simon (1983) as a source for the rational or synoptic model:

 

Simon H.A. (1983) Reason in human affairs. Oxford: Basil Blackwell.

Plus, for the incremental model:

Lindblom, C.E. 1979. Still muddling, not yet through. Public Administration Review 39: 517–526.

If needed, online, you will find accounts and diagrams on problem solving, the nursing process, case formulation and policy formulation. That's quite a family is it not? 

While not referred to as explicitly today, the nursing process (now routinized) should address parity and integrate care across mental and physical health. The individual (person, patient) should be assessed and care planned with their social and community context taken into account. Collaboration in care should help assure that this is indeed the case. The nursing process in the sociological domain acknowledges the role of parents, guardians, and families as informal carers. The social care sector can also be represented and further the objectives of a more open and integrated care community as per the local situation. While not added to the sciences domain; case formulation should also factor in the physical and political. 

Politically, are all instances of problem solving, and formulation recognised for their importance and influence on outcomes and effectiveness, economy, efficiency (another 'box' p.357), plus efficacy? Are services politically afforded the resources, as defined across the domains of Hodges' model required to deliver, improve and change (achieve sustainability, educational, preventive)? 

The elephant here of course are the determinantS. Ultimately, all these forms of problem solving should be at 'home' in the political domain, but they are rarely there. It is not just the practitioner who can make the difference - be the difference.

Enough of l-implementation

Policy needs to be fit for 21st century purposes, and not hollowed-out but allowed out - beyond the legislative walls where it can make a real difference.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

Nursing process Case  formulation	Nursing process
Nursing process Case  formulation	Policy formulation

    

See also: https://herbertsimonsociety.org/

 'nursing process' : 'case formulation'

In search of socio-political logics

'The logic of appropriateness refers to actions which members of an institution take to conform to its norms. For example, a head of state will perform ceremonial duties because it is an official obligation. By contrast, the logic of consequences denotes behaviour directed at achieving an individual goal such as promotion or re-election.' p.87.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

'Institutions are far more than the theatre within which the political drama unfolds; they also shape the script (Peters, 1999). This emphasis within the institutional framework on the symbolic or ritual aspect of political behaviour contrasts with the view of politicians and bureaucrats as rational, instrumental actors who define their own goals independently of the organization they represent.' p.87.

'Further, institutions bring forth activity which takes place simply because it is expected, not because it has any deeper political motive. When a legislative committee holds hearings on a topic, it may be more concerned to be seen to be doing its job than to probe the topic itself. Much political action is best understood by reference to this logic of appropriateness rather than a logic of consequences. For instance, when a president visits an area devastated by floods, he is not necessarily seeking to direct relief operations or to achieve any purpose other than to be seen to be performing his duty of showing concern. In itself, the tour achieves the goal of meeting expectations arising from the actor's institutional position. "Don't just do something, stand there", said Ronald Reagan, a president with a fine grasp of the logic of appropriateness.' pp.86-87.

    

See also: 'drama' : 'bridges'

Hague, R., & Harrop, M. (2007). Comparative Government and Politics (7th ed.). New York, NY: Palgrave Macmillan.

Peters, B. Guy. (1999). Institutional theory in political science: the new institutionalism. London: Pinter.

Remember (if you can) in each care domain ...

... there is an elephant in the 'room'!

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

	© Charlie Bibby/FT 'Game of tag:  the label on Ikea's elephant is almost twice its height'

    

'If there is one product that symbolises the absurdities of the EU's single market in goods, it might be a cuddly elephant. The Djungelskog toy from Ikea may only be 12cm tall and cost less than €2, but it has a 20cm-long label protruding from its behind.

Environmental rules from France and EU textile legislation account for much of the length. But the elongated label reflects a strategic even a philosophical, problem for Europe as its companies battle to compete globally.

The single market in goods should be the EU's crowning achievement. Compared with free movement of people, services or capital, it is the area that has come furthest in more than 30 years since the common market was established.

Yet there remain small, often invisible barriers to trade that, taken together, amount to what the IMF estimates is a drag on Europe's economy equivalent to a tariff of 44 per cent.'

RICHARD MILNE - OSLO and SAM JOINER - LONDON, Elephant in the room hampers frictionless EU trade, FTWeekend, 6-7 December 2025, p.6.

Related?

Jones, P. (1996) Nursing Technology and Elephants - Part 1: Technology as a beast of burden. IT in Nursing. 8,1,4-6.

Jones, P. (1996) Nursing Technology and Elephants - Part 2: Technology as a serpent. IT in Nursing. 8,2,5-7.

Jones, P. (1996) Nursing Technology and Elephants - Part 3: Technology rope to save humanity and health care, IT in Nursing. 8,3,5-7.

AI - World Models

'What Is a World Model?

World models are neural networks that understand the dynamics of the real world, including physics and spatial properties. They can use input data, including text, image, video, and movement, to generate videos that simulate realistic physical environments. Physical AI developers use world models to generate custom synthetic data or downstream AI models for training robots and autonomous vehicles.'

https://www.nvidia.com/en-us/glossary/world-models/

In healthcare a 'world model' is slightly more expansive, hence the importance of experienced humans. We call these - nurses, doctors, physiotherapists, occupational therapists, social workers and many other professions, support workers and disciplines. They learn and train for many years and must continue to learn and unlearn throughout their careers. Their work and engagement is shaped and directed by human values, which are in turn informed by social change, evidence-based research, professional guidance, policy and law.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

	WORLD MODEL

The critical pathway leads to ...?

I missed the most salient information on this book's cover - at least for me. My copy is secondhand, but I picked the copy up recalling Dr Walsh's many publications on models of nursing.

The critical pathway for me is plural. It would include, the CPN(Cert.) course when I first encountered Hodges' model in 1987-8. Plus the fact that the pathway is not unidirectional, with some backward steps and reviews, but is multifold. Running the axes of Hodges' model to - pre-op, surgery, post-op, rehab ... we can add the whole corpus of nursing, social, self, and global health care.

The cover is of course illustrative, intended to support the title and suggest an explicit critical pathway. Apart from possibly pointing to collaboration "Mr Jones ... Let us discuss your critical pathway!" what has changed? Since the book's publication in 1997, we need health care services and systems to be sustainable. We are bit late here. Mr Jones is already a 'patient', bedecked in dressing gown and slippers.

This critical pathway needs to be replaced by one informed and oriented towards Mr Jones as self-caring citizen. This is of course easier said than done in policy terms. While governments globally and institutions stress the need for health literacy, informed life style choices, self-care, health promotion and prevention how much progress is being made? Nutrition remains a profound issue.*

The environmental challenges of climate change, pollution and waste disposal are seemingly contested even as the effects and cost of non-action are increasingly obvious.

The policy of 'care in the community' even while incomplete in the community, has provided me with a stimulating, challenging and rewarding career 1985 ... In the 21st century though, we have to ask of the assessment of mobility to follow and effort of the up-hill walk to 'home' begs the critical pathway that is now Planetary Health.

<>

Several points from Walsh (1997):

'Introducing a model to a clinical area is not an easy task to be undertaken lightly, as it involves fundamental changes in the way staff think and work. Luker (1988) has suggested that each nurse carries around their own informal model of nursing which guides their practice. It is probable that a formal model will be significantly different, although these differences can be minimized by full consultation and involvement with staff to ensure that the model chosen reflects their views of nursing as far as possible.' p.36.

Hodges' model can be 'carried around'. In truth it not strictly a model of nursing. Its scope extends beyond nursing and yet the model can incorporate thought about the patient, nurse, environment and what health, illness, recovery and self-care entail. Hodges' model is meta-cognitive and meta-conceptual, and (very) capable of mapping the terrain (p.26) of nursing from these and other perspectives. A nurse's 'views of nursing' will be dictated by the situation presented to them. Hodges' model can be retrospective, prospective and operate in the here-and-now: situated.

'There is a further point, however, that follows on from Luker's observation for expert nurses have an internalized model of care which is unique to them, it is possible that they may have internalized some practices which are outdated, taken for granted or inappropriate (Paley, 1996) but which are never made explicit as their care is not based upon a commonly understood model of nursing. This notion of every nurse having their own model therefore can lead to the situation where outdated rituals can be propagated under the guise of expert practice. Having a series of explicit models whose aims and ideas are common knowledge, shared by all, opens up care to critical scrutiny in a way that is not possible if each nurse has their own private internal model.' p.37.

Hodges' model can be used with other models, conceptual frameworks and systems across disiplines. Hodges' model is not intended to be prescriptive or prospective. It can be utilised for learning and unlearning. As a registered General Nurse who studied in the 1980s this does not mean I would be competent and safe to practice now. Continuing professional development, mandatory training and revalidation of nursing registration are all geared to support professional practice that has currency, validity, and is safe.

If nursing ever needed a commonly understood model ...?

'It will be apparent from the previous sections that use of a model will lead nursing into some new and unfamiliar territory that will involve seeing the patient in a more holistic fashion'. p.63.

'The nurse may find that models start to identify environmental problems whose solutions lie beyond the boundaries of nursing at present. This is particularly true of the community nurse.' p.63.

Walsh's concern here is the immediate community, but we can recognise the prescience of environmental problems here. Plus the need for the POLITICAL domain in Hodges' model:

'On a larger scale still, perhaps some patient's problems have their origins in political decisions made by national govemment or perhaps it is the factory down the road producing unacceptable levels of pollution. If nursing models make us recognize the political and environmental causes of some patient problems, there should ee no logical reason why nursing should not go forward into theee arenas as a legitimate part of nursing intervention.' p.63.

'There are senior NHS managers and health academics in so-called 'policy thínk tanks' who simply do not recognize the value of nursing and see only a collection of simpie tasks which anybody with an NVQ level 2 can perform. Nursing therefore has to demonstrate its worth; it has to evaluate what it is doing for patients.

Here it is important to remember that the care given may be very different from what is written down. Consequently, how a nurse evaluates care mentally may be very different from how this care is recorded in nursing process documentation. ...' p.64.

Hodges' model can (imho) have a role in argumentation for the quality and scope of healthcare, for nursing as a profession, evaluating and assuring nursing's values in the constant that are the demands of complexity and change. The (several) determinants of health are the other constant.

Mike Walsh (1997) Models and Critical Pathways in Clinical Nursing. London: Bailliere Tindall.

Luker K. (1988) Do Models Work? Nursing Times, 84 (5), 27-29.

Paley, J. (1996), Intuition and expertise: comments on the Benner debate. Journal of Advanced Nursing, 23: 665-671. https://doi.org/10.1111/j.1365-2648.1996.tb00035.x

*Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: doi:10.1136/bmjnph-2021-000254

Wirnitzer KC, Motevalli M, Tanous DR, Drenowatz C, Moser M, Cramer H, Rosemann T, Wagner K-H, Michalsen A, Knechtle B, Fras Z, Ritskes-Hoitinga M, Marques A, Mis NF, Stanford FC, Schubert C, Goswami N, Leitzmann C, Fredriksen PM, Ruedl G, Wilflingseder D, Lima RA, Kessler C, Jeitler M, Khan NA, Joulaei H, Fatemi M, Knight A, Kratky KW, Palmer KK, Haditsch B, Jakse B, Kofler W, Pfeiffer T, Cordova-Pozo K, Tortella P, Straub S, Lynch H, Schätzer M, Krishnan A, Fathima A. S, Gatterer L, Kriwan F, Abhishek M, Nandgaonkar H, Nandgaonkar S, Adedara AO, Haro JM, Gericke C, Neumann G, Akhtar A, Rashidlamir A, Thangavelu M, Ngoumou GB, Perpék É, Klaper M, Bhattacharya B, Kirschner W, Bessems KMHH, Jones P, Peoples G, Bescos R, Duftner C, Seifert G (2025). Toward a roadmap for addressing today's health dilemma–The 101-statement consensus report., 

Frontiers in Nutrition, Volume 12:1676080. doi: 10.3389/fnut.2025.1676080. https://doi.org/10.3389/fnut.2025.1676080

Conquering Today's Health Paradox with the Power of HEAL – An Expert Consensus Report plus Research Priorities and Policymaker Roadmap

A further post will follow with full PR, but the paper is now published:

Article type: Policy Brief
Journal: Frontiers in Public Health - Public Health Education and Promotion
Manuscript ID: 1695757
Received on date: 30 Aug 2025

Abstract

Background. Despite growing scientific evidence and health guidelines, the global health paradox persists, with rising lifestyle-related diseases and escalating healthcare costs exposing the inadequacy of current efforts.

Objective. 3 multidisciplinary congresses were held to generate evidence-based conclusions to tackle the global health paradox.

Methods. 58 experts from 62 entities participated in the international research and knowledge exchange panels. Experts reviewed the latest findings to develop practical strategies, key research and policy priorities, focusing on the “Healthy Eating & Active Living” (HEAL) approach.

Results, Conclusions, and Relevance. The expert consortium endorsed a 33 evidence-based consensual-statement policy roadmap for addressing global health challenges, emphasizing the HEAL approach can significantly contribute to the “Prevention First” appeal and broad ethical, social, ecological, and economic advantages, and eventually policy change.

Wirnitzer KC, Motevalli M, Tanous DR, Drenowatz C, Moser M, Cramer H, Rosemann T, Wagner K-H, Michalsen A, Knechtle B, Fras Z, Ritskes-Hoitinga M, Marques A, Mis NF, Stanford FC, Schubert C, Goswami N, Leitzmann C, Fredriksen PM, Ruedl G, Wilflingseder D, Lima RA, Kessler C, Jeitler M, Khan NA, Joulaei H, Fatemi M, Knight A, Kratky KW, Palmer KK, Haditsch B, Jakse B, Kofler W, Pfeiffer T, Cordova-Pozo K, Tortella P, Straub S, Lynch H, Schätzer M, Krishnan A, Fathima A. S, Gatterer L, Kriwan F, Abhishek M, Nandgaonkar H, Nandgaonkar S, Adedara AO, Haro JM, Gericke C, Neumann G, Akhtar A, Rashidlamir A, Thangavelu M, Ngoumou GB, Perpék É, Klaper M, Bhattacharya B, Kirschner W, Bessems KMHH, Jones P, Peoples G, Bescos R, Duftner C, Seifert G (2025). Toward a roadmap for addressing today’s health dilemma–The 101-statement consensus report. Frontiers in Nutrition, Volume 12:1676080. doi:10.3389/fnut.2025.1676080.

 https://doi.org/10.3389/fnut.2025.1676080

Yuki Kihara: Darwin in Paradise Camp - The Whitworth, Manchester

3 October 2025 – 1 March 2026

'A visually stunning exhibition centring Indigenous, queer worlds by Japanese-Sāmoan artist Yuki Kihara.

The Whitworth is proud to present Yuki Kihara’s acclaimed installation Paradise Camp (2022), first presented at the Aotearoa New Zealand Pavilion in the 59th Venice Biennale in 2022, and a new video work, Darwin Drag (2025).

Kihara delves into art histories and archives to unpick the effects of colonialism on the peoples and ecologies of the Pacific. Her visually compelling projects centre and empower the Fa’afafine and Fa’atama in Sāmoa, traditional yet marginalised third gender communities to which the artist belongs. In this exhibition, Kihara focuses on two celebrated Western figures – French modernist artist Paul Gauguin and evolutionary biologist Charles Darwin (1809-1882) – who each shaped Western understandings of the Pacific.

Paradise Camp responds to famous paintings of Tahiti and its people by French modernist artist Paul Gauguin (1848-1903). Through archival research, Kihara links Gauguin’s paintings to colonial photographs taken in Sāmoa. Described by Kihara as an act of 'upcycling', she recreates Gauguin’s compositions in a series of 12 resplendent high definition photographs, shot on location in Upolu Island. Collaborating with Fa’afafine models and production crew, Kihara repurposes these cultural artefacts to speak to, and from, queer Indigenous worlds in a profound gesture of reclamation.'

Continued ... 
https://www.whitworth.manchester.ac.uk/whats-on/exhibitions/yukikihara/

individual

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INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

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group-population

My source:

Josh Lustig. Yuki Kihara, Gallery, FT Magazine, November 22, 2025, #1152. pp.12-13.